Duodenal carcinoid tumors are uncommon. It is unknown if they behave more like carcinoids in the appendix (indolent course) or those in the ileum (often virulent)crucial information for determining the need for radical resection.
AIM: To evaluate treatment and outcomes of patients with duodenal carcinoid.
METHODS: We conducted a retrospective review of all patients at our tertiary referral center with primary duodenal carcinoid from 1976-1999. Functional islet cell tumors were excluded.
RESULTS: 27 patients (15 M, 12 F) with a median age of 66 (range 43-86) were evaluated. Over half (52%) were diagnosed in the period 1995-99. The most common pre-treatment symptom was abdominal pain (50%); other symptoms included nausea, vomiting, weight loss, GI blood loss, pancreatitis, and GERD. Four patients were asymptomatic. Endoscopic biopsy provided diagnosis in 78%. No patient had other synchronous GI carcinoid tumors, but 9 had another primary malignancy. Sixteen carcinoid tumors were located in the first portion of the duodenum (D1), 9 were in D2 (2 periampullary), and 2 in D3/D4. Treatment was by endoscopic excision in 11, transduodenal excision in 8, pancreaticoduodenectomy in 4, segmental excision of D3/D4 in 2, and palliative operation in 1. One patient did not undergo operation due to comorbidities. All 11 patients treated with endoscopic excision had tumors £ 1.0 cm. One was lost to follow up, the other 10 are alive and tumor free (median follow up 3.4 years, range 0.2-8). The one recurrence in this group was successfully treated by endoscopic re-excision (no recurrence 7 years later). Thirteen patients (mean tumor size: 2.3 cm; range: 0.4-8 cm underwent operative excision with curative intent (median follow up: 4.3 years, range 1.5-23); one had nodal metastasis at operation. Three died of tumor, 4 are alive with hepatic metastasis, and 6 remain tumor free. Three patients in this series later developed carcinoid syndrome (flushing, diarrhea, or asthma).
CONCLUSIONS: Duodenal carcinoid tumors appear to act like appendiceal carcinoids with a good prognosis for small tumors, though many are associated with other malignancies. Endoscopic excision of tumors £ 1.0 cm provides appropriate therapy, though endoscopic follow up is indicated. Patients with larger tumors probably benefit from more aggressive locoregional resection.